Extended Scalp Flaps for Extensive Soft Tissue Scalp Defects as a Day Surgery Procedure Under Local Anesthetic: A Single Centre Experience

Abstract

Background Cutaneous malignancies are on the rise, associated with an increased number in scalp cancers that require wide local excision (WLE) to ensure clearance; the inelastic nature of the scalp poses a particular challenge when dealing with such large defects.

Case presentation A series of 68 cases with large scalp defects following WLE for the clearance of squamous cell carcinoma, atypical fibroxanthoma, dermatofibrosarcoma protuberans, and melanoma skin cancers are presented. These cases were treated in one center under local anesthesia and underwent extended scalp flaps to close the resulting defect primarily without the use of skin grafts for the flap donor site on the scalp.

Conclusion Extended scalp flap is a safe and reproducible solution for extensive scalp defects, which results in quicker wound healing with cosmetically superior results, and can be performed safely and comfortably under local anesthesia in the day case setting.

Keywords

scalp flap - skin cancers - head and neck cancer - cutaneous malignancy

Publication History

Received: 04 December 2019

Accepted: 22 June 2020

Article published online:
04 February 2021

• References

• 1 Rogers HW, Coldiron BM. Analysis of skin cancer treatment and costs in the United States Medicare population, 1996-2008. Dermatol Surg 2013; 39 (1 Pt 1): 35-42
• 2 Buckingham ED, Quinn FB, Calhoun KH. Optimal design of O-to-Z flaps for closure of facial skin defects. Arch Facial Plast Surg 2003; 5 (01) 92-95
• 3 Arpey CJ. Random-pattern flaps. New York, NY: McGraw-Hill; 1997: 222
• 4 Bo B, Qun Y, Zheming P, Haitao X, Tianyi L. Reconstruction scalp defects after malignant tumor resection with anterolateral thigh flaps. J Craniofac Surg 2011; 22 (06) 2208-2211
• 5 Sweeny L, Eby B, Magnuson JS, Carroll WR, Rosenthal EL. Reconstruction of scalp defects with the radial forearm free flap. Head Neck Oncol 2012; 4 (04) 21
• 6 Hierner R, van Loon J, Goffin J, van Calenbergh F. Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: report of 7 cases. Microsurgery 2007; 27 (05) 425-428
• 7 Tanaka K, Sakuraba M, Miyamoto S. et al. Analysis of operative mortality and post-operative lethal complications after head and neck reconstruction with free tissue transfer. Jpn J Clin Oncol 2011; 41 (06) 758-763
• 8 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116 (04) 54e-72e
• 9 Becker GD, Adams LA, Levin BC. Secondary intention healing of exposed scalp and forehead bone after Mohs surgery. Otolaryngol Head Neck Surg 1999; 121 (06) 751-754
• 10 Angelos PC, Downs BW. Options for the management of forehead and scalp defects. Facial Plast Surg Clin North Am 2009; 17 (03) 379-393
• 11 Earnest LM, Byrne PJ. Scalp reconstruction. Facial Plast Surg Clin North Am 2005; 13 (02) 345-353 , vii
• 12 Tolhurst DE, Carstens MH, Greco RJ, Hurwitz DJ. The surgical anatomy of the scalp. Plast Reconstr Surg 1991; 87 (04) 603-612 , discussion 613–614
• 13 Raposio E, Santi PL, Nordström RE. Serial scalp reductions: a biomechanical approach. Dermatol Surg 1999; 25 (03) 210-214
• 14 Temple CL, Ross DC. Scalp and forehead reconstruction. Clin Plast Surg 2005; 32 (03) 377-390 , vi–vii
• 15 Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 1999; 103 (02) 403-411
• 16 Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg 2004; 6 (01) 16-20